A retrospective review of post-intubation sedation and analgesia practices in a South African private ambulance service

INTRODUCTION: Adequate post-intubation sedation and analgesia (PISA) practices are important in the pre-hospital setting where vibration and noise of the transport vehicle may contribute to anxiety and pain in the patient. These practices are poorly described in the pre-hospital setting. This study aims to describe the current pre-hospital PISA practices in a private South African (SA) emergency medical service. METHODOLOGY: Patient report forms (PRF) of intubated patients between 1 Jan 2017 and 31 Dec 2017 from a private ambulance service were reviewed. The data were analysed descriptively. Correlations between receiving PISA and various predictive factors were calculated with Spearman's Rank correlations and differences between intubation method were calculated with independent t-tests and Mann-Whitney U tests. A binomial regression model was used to determine predictive factors of receiving PISA. RESULTS: The number of PRFs included for analysis was 437. Of these, 69% of patients received PISA. The estimated time from intubation to 1st PISA ranged from 9 to 12 min. There were statistically significantly more PISA interventions in patients who had received Rocuronium (p < 0.01). There was weak correlation between the number of interventions and the mean arterial pressure, (p < 0.05) and with the transport time to hospital (r(s) = -0.77, p < 0.01). CONCLUSION: Sixty nine percent of patients who are intubated pre-hospital receive PISA, which leaves up to 30% without PISA. The time to 1st PISA appears to be shorter in the SA setting. There is an increased number of interventions in the patients who received Rocuronium, which may indicate practitioners being mindful of wakeful paralysis. Patients intubated with RSI are more likely to receive PISA and practitioners take the blood pressure prior to and after intubation into account when administering PISA. Longer transport times attribute to patients receiving more PISA interventions.